Assessment of inflammatory parameters in obstructive coronary artery disease and cardiac syndrome X: an evolving value of neutrophil-lymphocyte ratio

Abstract

Objectives: Atherosclerosis represents an active inflammation that leukocytes play a major role. Neutrophillymphocyte ratio (NLR) has been shown as an indicator of systemic inflammation. Our aim was to evaluateinflammatory markers in obstructive coronary artery disease (CAD) and cardiac syndrome X (CSX) and toevaluate NLR in predicting CAD in patients with typical chest pain and coronary risk factors.Methods: Eighty patients with CSX, 80 patients with obstructive CAD with unstable angina pectoris and acontrol group of 80 subjects were recruited into the study. Hematologic and biochemical parameters wereinvestigated.Results: High-sensitive C-reactive protein (hs-CRP) was increased in CAD group and CSX group comparedto the control group (p < 0.001); however it was comparable between CAD and CSX groups (p = 0.065). MeanNLR was higher in CAD group than CSX group and control group that the lowest value was in the controlgroup. In CAD group, hs-CRP was positively correlated with NLR (r = 0.43, p < 0.001), and Gensini score (r= 0.54, p < 0.001). NLR was also linearly correlated with Gensini score (r = 0.49, p < 0.001). In ROC curveanalysis, for the NLR of 2.26, NLR values attained 85.5% sensitivity and 43.9% specificity (p < 0.001). Whencut-off value was taken as 3.05 mg/dL for CRP, CRP values attained 78.7% sensitivity and 43.6% specificity(p < 0.001). When cut-off value was taken as 9.5 (×109/L) for white blood cell (WBC), WBC values attained58.8% sensitivity and 34.3% specificity (p < 0.001).Conclusions: NLR seems to be usefull in prediction of obstructive CAD and can be implemented in planningfor diagnostic procedures in patients with typical chest pain. Increased CRP, WBC and NLR may give insightabout main pathology of CSX. Despite absence of obstructive narrowing in epicardial coronaries, it appearsbe salutary to treat CSX due to the similar underlying pathophysiology with obstructive CAD.